Pharmacology FinalBlueprint

Part 1…Includes:Antihistamines, antitussives, asthma meds, decongestants, expectorants,

antihypertensives, antimigraines, antiepileptics, antiparkinsonians,

psychotherapeutics, & sedative hypnotics

Thiazide Diuretics Drug of choice for hypertension b/c:

› Cheap, available, well-tolerated Can cause hypokalemia b/c they induce urinary loss

w/o protecting potassium Used to decrease fluid overload Cause the kidneys to excrete sodium and water into

the urine resulting in less fluid in the blood causing a reduction in blood pressure

Prevent the reabsorption of sodium and chloride through direct action on the end of the ascending loop and beginning of the distal tubule of the Loop of Henle

Promotes the reabsorption of calcium Directly dilates the smooth muscles in the arterioles

DiureticsDrug of choice for hypertension

ACE Inhibitors

Beta Blockers

Beta Blocker Teaching

Statins Taken w/ dinner because the body

naturally produces more cholesterol between midnight and 5 am

May affect liver function & not for use with pregnant women

Drugs used to lower cholesterol act by blocking the substances the body needs to make cholesterol

May also help your body reabsorb cholesterol that has built up in plaques in artery walls preventing further blockage

Zocor Side Effects

Statin medication Gastrointestinal disorders, myalgia,

arthralgia, upper respiratory infections, headache, abdominal pain, constipation, N/V, pruritus, alopecia, pancreatitis, paresthesia, peripheral neuropathy, anemia, depression

Flomax

Tamsulosin Used to treat BPH Alpha-adrenergic blocker; relaxes the

muscles in the prostate and bladder to allow urine to flow easily

What is stepped care?Stepped care is a medication management plan starting with the least invasive drugs and progressing as needed to more invasive drugs.

Vital signs needed with nitro

Blood pressure and pulse before administration

Side effects of nitrates

What are common medications for angina?

What is long-acting nitrate for?

Long acting nitrates and topical, transdermal, transmucosal, and oral sustained-release nitroglycerin products are used:› to prevent or treat anginal attacks WHEN they are

likely to occur Like during exercise

› To reduce the severity and frequency of anginal attacts

› To reduce the work in the heart in cases of MI & chronic heart failure

› For relief of gallbladder GI, urethral, and bronchial smooth muscle pain

How to decrease nitroglycerin?

What is important about the storage of nitroglycerin?

Nitroglycerin instructions…

•Take on an empty stomach, no alcoholic beverages, & minimize foods/drinks w/ caffeine•Pt. can develop a tolerance•In hospital blood pressure should be taken before dosing and between doses•Pt. should keep a record of all anginal attacks•Pt. should use nitro when an attack is expected•Meds are only part of the therapy…weight loss, avoiding triggers, and exercise are important•Keep out of reach of children

Why take andrenergic blockers?

Part of the andrenergic antagonist class that assists in lowering cardiac output and/or peripheral resistance.

Sympathetic nervous system relies on 2 andrenergic neurohormones or neurotransmitters, epinephrine and norepinephrine.

Andrenergic inhibitors (blockers) occupy the adrenergic receptors to prevent stimulation

Lowers blood pressure by stopping epi/norepi which relaxes the walls of the blood vessels and lets the heart pump more slowly and easily

Used in the treatment of HTN

Andrenergic blockers other uses

Can be used to treat benign prostatic hyperplasia

Andrenergic blocker side effects

Narrow Margin for Digoxin

Therapeutic levels are 0.5 to 2 ng/mL (nanograms per milliliter)

Toxic levels 2.5 ng/mL or more “Narrow Margin” refers to the concept

that the Therapeutic and Toxic levels are very close

What are signs of digoxin toxicity?

One of the earliest symptoms is often extreme fatigue!

Atropine counteracts digoxin toxicity!

Lanoxin/Digoxin Oral

Used to treat heart failure and abnormal heart rhythms (arrhythmias)/atrial afibrillation

Furosemide

Loop diuretic Used to treat high blood pressure & the

fluid retention caused by heart and liver disease

Lasik

Lopressor

Peripheral vasodilator Metoprolol Used alone or in combination with

other medications to treat high blood pressure, prevent angina, and to improve survival after a heart attack

Verapamil

Calcium Channel blocker Used to treat high blood pressure and

control angina Relaxes the blood vessels so that the heart

doesn’t have to work as hard They selectively limit the passage of

extracellular calcium ions through specific ion channels of the cell membrane in cardiac, vascular, and smooth muscle cells which causes a lowered peripheral vascular resistance & a fall in systolic and diastolic bp

Pyridium

Restoril Benzodiazepine Sedative-hypnotic

indicated for the short term treatment (7-10 days) of insomnia

Induces sleep in 20-40 minutes Generally in 30 mg doses for adults; in

elderly or debilitated patients 15 mg doses

SE = drowsiness, headache, fatigue, nervousness, lethargy, hangover, N/V/D, anorexia, ataxia, tremor, dyspnea, palpitations, amnesia, & hallucinations

Lithium & BW

Primary drug used to treat patients in a manic state

Therapeutic levels are close to toxic levels, so serum lithium level must be monitored on a regular basis.

Blood should be drawn 12 hours after the dose of lithium is given.

Monitoring should be carried out every few days during the initial therapy and at least every 2 months thereafter

Therapeutic level is 1 to 1.5 mEq/L

What is the special teaching about Dilantin?What is the initial dose?

Patients taking hydantoins (like Dilantin) should see a dentist every 6 months & maintain good oral hygiene brushing teeth and gums twice a day with a soft toothbrushing and rinsing well

Initial dose: Children 5 mg/kg/day PO in 2 or 3 equally

divided doses initially Adults 100 mg PO 3 times daily initially

What is Elavil/Welbutrin used for?

Elavil› Amitriptyline/elavil is a tricyclic

antidepressant used to treat the symptoms of endogenous depression

Welbutrin› Buproprion/welbutrin is an antidepressant

that worked in the brain to treat major depression, seasonal affective disorder, and for smoking cessation

MAO inhibitor teachings…

MAO inhibitors

Block the inactivation of the biogenic amines resulting in an increased concentration of dopamine, epinephrine, norepinephrine, and serotonin at neuronal synapses

Used to relieve the symptoms of severe reactive or endogenous depression that have NOT responded to tricyclic antidepressant therapy, electro-convulsive therapy, or other modes of psychotherapy

Ritalin

CNS stimulant intended to treat ADD, ADHD, & narcolepsy

Paxil

SSRI indicated for the treatment of major depression, panic disorder, OCD, generalized anxiety disorder, social anxiety disorder, PTSD

NOT to be used concurrently with MAO inhibitors

Aricept

Reversible acetyl cholinesterase inhibitor

Indicated for the treatment of dementia of the Alzheimer’s type

Should be taken in the evening w/ or w/o food

Antiparkinson Meds

Goal of Parkinson Treatment There is no known cure for Parkinson’s Treatment goals are designed to relieve

symptoms and maintain movement and activity of the patient

Symptoms are controlled by changing the neurotransmitters produced in the brain

Two main actions: Block uptake of acetylcholine at postsynaptic

muscarinic cholinergic receptor sites Elevate the functional levels of dopamine in

motor regulatory centers

Antimigraine Teachings

Imitrex Serotonin (5-HT) Receptor Agonist Indicated for use as an antimigraine in

adults that have migraines with no aura

Serious cardiac & hypertensive crises have occurred with the use of imitrex

Not for use with MAOIs Not for use in patients with history of

ischemic or cerebrovascular syndromes

Valium Diazepam Indicated for the treatment or management of:

› Anxiety› Alcohol withdrawal tremors› Relief of skeletal muscle spasm› Spasticity from cerebral palsy or paraplegia› Athetosis› Epilepsy› Tetanus

Can be habit forming Diazepines accumulate in the adipose tissue, which

substantially increases their half-life, making them dangerous, particularly for elderly patients

Abrupt termination of these agents may cause delayed withdrawal up to a week later

Expectorant Teachings – agents that decrease the thickness of respiratory secretions

Decongestants & Hypertension When the drugs are absorbed from the

GI tract, systemic effects such as nervousness, nausea, dizziness, tachycardia, dysrhythmia & a transient INCREASE in blood pressure may occur

Should be used with caution in stable hypertensive patients on guanethidine, bethanidine, or debrisoquine sulfate

Antitussives & Addiction Antitussives are used to relieve

overactive or nonproductive coughs Narcotic antitussives may cause drug

dependence Some narcotic antitussives are

Schedule II controlled substances

Antihistamine Dosing Over dosage is potentially fatal, especially in

children Infants/young children often have anticholinergic

side effects Pediatric patients w/ spastic paralysis or brain

damage often need lower dosing In hot weather children have an increased risk of

developing rapid body temp increase Dosage adjustments are needed for infants, Down

Syndrome, & blonds Elderly patients need lower doses because they

are susceptible to developing extrapyramidal reactions and paradoxical reactions

“Go Slow and Stay Low” is important

How antihistamines affect vitals As adverse reactions…antihistamines can

actually cause both hypertension and hypotension

They block the action of histamine by competing with it for the H1 receptor sites on the “effector structures” which limits the vasodilation and increases capillary permeability and reduces the edema caused by histamine

Nurses should monitor pulse and blood pressure before and during therapy

Nurse should assess lung sounds and character of bronchial secretions

Extrapyramidal Effects

A group of adverse reactions occurring on the extrapyramidal portion of the nervous system

Parkinson like symptoms› Akathisia› Dystonia

Tardive Dyskinesia (TD)› Syndrome of potentially irreversible involuntary rhythmic

movements of the tongue, face, mouth, jaw, or extremities.

› May occur in patients who are on antipsychotic drugs or after discontinuing such drugs

› There is NO known treatment› When it occurs the drug must be discontinued

Treatment for Asthma

How are antibiotics chosen? Each infection in a patient must be carefully

evaluated to identify the specific organism causing the infection and the drug that will be most effective against it

Whenever possible cultures should be drawn before starting antibiotic therapy…you may need to culture sputum, urine, blood, wound, or nonhealing sites on the skin

The type of infection will dictate the antibiotic used and whether treatment guidelines apply

Diagnosis of previous food/drug allergies, dementia, and dehydration may all influence the drug ordered, the dosage, & the rate of administration

Broad Spectrum Antibiotics

Antibiotics effective against a wide variety of organisms

Act in different ways to affect pathogenic bacteria…may attack a bacterium’s internal cell processes or they may destroy the external cell wall

Many cross the placental barrier and are secreted in breast milk

Penicillin Interferes with creation of mucopeptide cell wall Main antibiotics for many years Allergy to penicillin has increased over the years

as has the development of penicillin resistant diseases…these are the result of overuse of penicillin to treat infections for which they were not effective

Broad spectrum drug of choice for susceptible gram-positive and gram-negative organisms

Also used for prophylactic treatment against bacterial endocarditis in patients with rheumatic or congenital heart disease before surgery/dental

Some penicillins may be useful against organisms used by terrorists as bioweapons

Adverse reactions to penicillin

Antibiotics & Birth Control Pills

Some antibiotics and oral contraceptives together have produced menstrual irregularities and unplanned pregnancies

How do you know if aminoglycosides are working?

They have a narrow therapeutic range…closely monitor blood levels to avoid toxicity

Dosage is calculated by weight and increased to achieve blood level

This is all I could find…ask Cheryl Ball :lol:

Antibiotic Teaching Patient should:

› Take medication as prescribed and not stop because symptoms stop. Every dose should be taken

› Use care when bathing/brushing teeth to watch for signs of itching, irritation, & infection

› Notify HCP if rash, hives, decreased urination, diarrheas or other symptoms develop

› If treatment is for an STD, then sexual activity should cease until treatment is over and all partners should be tested/treated

› Drink water› Avoid excessive sunlight exposure